Poltronieri Anna, Patrini L, Pigatto P, Riboldi L, Marsili Chiara, Previdi M, Margonari M, Marraccini P
Scuola di Specializzazione in Medicina del Lavoro, Università di Milano.
Med Lav. 2010 Nov-Dec;101(6):403-8.
Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma.
In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate.
After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge.
The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms.
Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.
美发师会接触到可能导致接触性皮炎、鼻炎和哮喘的刺激性和致敏性化合物。
本文描述了一名33岁女性的病例，她在接触过硫酸铵10年后患上了接触性皮炎。
在7个月的时间里，皮肤病变逐渐广泛且持续，随后出现了与职业暴露相关的呼吸道症状（激发试验）。进行了针对美发师的SIDAPA和特定职业斑贴试验以及过硫酸铵职业激发试验。在特定支气管激发试验前后检测炎症的临床参数、嗜酸性粒细胞阳离子蛋白（ECP）和呼出一氧化氮（FeNO）。
斑贴试验对过硫酸铵呈阳性反应（++），过硫酸铵支气管激发试验显示出显著的迟发反应（第一秒用力呼气容积下降33%）。24小时后，FeNO和ECP均显著升高。由于空气传播接触，未覆盖皮肤处出现皮炎、荨麻疹和血管性水肿。局部使用类固醇和抗组胺药物缓解了临床症状。
实际上，支气管激发试验被认为是职业性哮喘诊断的金标准，尽管新的炎症参数有助于诊断，并且在使用职业性过敏原进行特定吸入试验后可用于监测。所描述的病例总结了从接触性皮炎到吸入性过敏的演变过程，提示职业性过敏发生了过敏性“进展”。
